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Canvasback Missions' Wellness Center on Majuro, Marshall Islands received a grant from the Small Grants Programme of the United Nations Development Programme (UNDP) to run a new public health program aiming to more effectively treat diabetes in individuals through lifestyle change.

The project, titled Community Health Advancement Program (CHAP), will take the principles of the Wellness Center's flagship two-week intensive Lifestyle Intervention program and apply them at the household level. These principles reduce the greatest risks of type 2 diabetes through daily exercise, a healthy plant-based diet, and home agriculture.

Instead of teaching these to a cohort over the course of two weeks, trained nurses, doctors, and Wellness Center staff will train households in these areas at their own homes over the course of two months. This will allow the health worker to teach cooking and exercise with the space and equipment a family has access to. Additionally, home gardens can be monitored over the course of the two-month intervention, allowing for further training if needed. Environmental factors inhibiting exercise and healthy eating can be addressed as well.

In addition to factoring in a household's context, this individualized attention has three more strengths. First, it allows for plenty of individualized attention—something difficult to do in group lifestyle interventions. Second, it accommodates those unable to come to the Wellness Center regularly or at scheduled times due to reduced mobility, time restrictions, work, or low income. Not only will health workers travel to households, but they will do so at convenient times. Third, it allows the opportunity to educate the family members of someone with diabetes as well as the household cook. Doing this will make sticking to a diet and exercise regimen more likely, due to the reduced social pressure resulting from understanding and education.

Household visits, like this one on Majuro in February 2017, can remove barriers to treatment to be more effective. Photo: Caitlin Dwyer.

Along with a number of programs in agriculture, healthy eating, and community health, the Wellness Center runs two other programs specifically teaching lifestyle intervention: the community lifestyle program, which finds undiagnosed or "truant" patients and the Lifestyle Intervention program described above.

Community Health Advancement Program will involve six nurses from the Marshall Islands Ministry of Health (MOH) Noncommunicable Diseases Clinic, two doctors from the MOH, and three Wellness Center staff.

The project period begins April 2017 and will last for two years. Canvasback Missions was awarded $25,320 for CHAP, and the total project cost is estimated to be $47,820.

This program was designed with community input and research, and we believe it will be more effective and community-driven as we aim for our goal of achieving epidemic control of type 2 diabetes on Majuro.